New Workers’ Comp Physician Fee Schedule Takes Effect

Today, July 1, the new workers’ compensation medical fee schedule becomes effective, marking the culmination of years of effort by the North Carolina Medical Society (NCMS) working with the Industrial Commission and other stakeholders to update the fee schedule and fix flaws in the billing and claims process. The Industrial Commission has now posted the Fee Schedule Table and FAQs.

“This is another great example of how the NCMS can effect positive change for our members and their patients,” said NCMS CEO Robert W. Seligson. “The old physician fee schedule — which had not been maintained since its adoption in 1995 — offered physicians some of the worst rates across the country. This had taken a toll on physician participation, making medical care more difficult for workers to find and more expensive for employers. Starting today we look forward to a more equitable and efficient system for injured workers.”

The NCMS and its Workers’ Comp Task Force along with payers, the business community and the state agencies that oversee the workers’ comp program had worked for several years to establish a fee schedule that successfully ensures injured workers can receive the care they need; medical providers are compensated at reasonable rates; and medical costs remain adequately contained. The old fee schedule had grown stale since its adoption in the mid-1990s, and no longer struck the necessary balance. The new schedule successfully balances these interests.

In addition to new payment rates, NCMS pushed for — and secured — additional changes that will resolve administrative hassles for medical practices. For instance, the Industrial Commission has abandoned the rule that medical providers must substantiate their claims to the carriers for injectable drugs and durable medical equipment with paper invoices. Physicians can now bill for these services with a specific code without the paperwork and be paid according to the fee schedule allowable for that item or service. The Commission also clarified other practitioners like physician assistants and nurse practitioners also are to be paid at the full fee schedule amount, so long as the services they provide are within their respective scopes of practice.

For more information visit the NCMS Workers’ Comp page on our website and watch the Bulletin for updates and analysis of what this may mean for your practice.